Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 8 | Aug, 2013

Nano-ceramic Composite Scaffolds for Bioreactor-based Bone Engineering

Qing Lv PhD, Meng Deng PhD, Bret D. Ulery PhD, Lakshmi S. Nair M.Phil, PhD, Cato T. Laurencin MD, PhD

Composites of biodegradable polymers and bioactive ceramics are candidates for tissue-engineered scaffolds that closely match the properties of bone. We previously developed a porous, three-dimensional poly (D,L-lactide-co-glycolide) (PLAGA)/nanohydroxyapatite (n-HA) scaffold as a potential bone tissue engineering matrix suitable for high-aspect ratio vessel (HARV) bioreactor applications. However, the physical and cellular properties of this scaffold are unknown. The present study aims to evaluate the effect of n-HA in modulating PLAGA scaffold properties and human mesenchymal stem cell (HMSC) responses in a HARV bioreactor.

Foreign Body Reaction to Acellular Dermal Matrix Allograft in Biologic Glenoid Resurfacing

Surena Namdari MD, MSc, Christopher Melnic MD, G. Russell Huffman MD, MPH

Biologic glenoid resurfacing is a treatment option for young patients with glenohumeral arthritis. An optimal synthetic graft for glenoid resurfacing should allow repopulation with host cells, be durable enough to tolerate suture fixation and forces across the joint, and present no host inflammatory response. We report two cases of giant cell reaction to GraftJacketafter biologic glenoid resurfacing.

The Crossover Sign Overestimates Acetabular Retroversion

Ira Zaltz MD, Bryan T. Kelly MD, Iftach Hetsroni MD, Asheesh Bedi MD

The crossover sign is a radiographic finding associated with cranial acetabular retroversion and has been associated with pincer-type femoroacetabular impingement (FAI) in patients with hip pain. Variable morphology, location, and size of the anterior inferior iliac spine (AIIS) may contribute to the crossover sign even in the absence of retroversion. Thus, the sign may overestimate the incidence of acetabular retroversion.

Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome

Giancarlo C. Polesello MD, PhD, Marcelo C. Queiroz MD, Benjamin G. Domb MD, Nelson K. Ono MD, PhD, Emerson K. Honda MD, PhD

While many authors have recommended surgery for patients with persistent symptoms of external snapping hip, it is unclear which one best relieves symptoms. Concerns with iliotibial band (ITB)-modifying techniques include altering the shape of the lateral thigh and overload of the contralateral abduction mechanism. We describe a new endoscopic technique that decreases the tension of the ITB complex by releasing the femoral insertion of the gluteus maximus tendon (GMT).

Do Professional Athletes Perform Better Than Recreational Athletes After Arthroscopy for Femoroacetabular Impingement?

Ajay Malviya FRCS (Tr & Orth), Christos P. Paliobeis MD, Richard N. Villar BSc, MA, MS

Although a large number of athletes’ returns to sports after hip arthroscopic surgery for femoroacetabular impingement (FAI), it is not clear if they do so to the preinjury level and whether professional athletes (PA) are more likely to return to the preinjury level compared with recreational athletes (RA).

Novel CT-based Three-dimensional Software Improves the Characterization of Cam Morphology

Michael T. Milone BA, Asheesh Bedi MD, Lazaros Poultsides MD, PhD, Erin Magennis BA, J. W. Thomas Byrd MD, Christopher M. Larson MD, Bryan T. Kelly MD

Incomplete correction of femoral offset and sphericity remains the leading cause for revision surgery for symptomatic femoroacetabular impingement (FAI). Because arthroscopic exploration is technically difficult, a detailed preoperative understanding of morphology is of paramount importance for preoperative decision-making.

Joint Space Predicts THA After Hip Arthroscopy in Patients 50 Years and Older

Marc J. Philippon MD, Karen K. Briggs MPH, John C. Carlisle MD, Diana C. Patterson BA

All patients considering joint-preserving hip arthroscopy should be educated on the risk of THA after arthroscopy. The degree of radiographic osteoarthritis predicts subsequent THA. To provide patients with the best information, the best radiographic measure that predicts THA after hip arthroscopy should be identified.

Anterior Inferior Iliac Spine Morphology Correlates With Hip Range of Motion: A Classification System and Dynamic Model

Iftach Hetsroni MD, Lazaros Poultsides MD, Asheesh Bedi MD, Christopher M. Larson MD, Bryan T. Kelly MD

The anterior inferior iliac spine (AIIS) contributes to hip dysfunction in patients with symptomatic impingement and resection of a prominent AIIS can reportedly improve function. However, the variability of the AIIS morphology and whether that variability correlates with risk of associated symptomatic impingement are unclear.

Spontaneous Hip Labrum Regrowth After Initial Surgical Débridement

Geoffrey D. Abrams, Marc R. Safran MD, Hassan Sadri MD

Anecdotal evidence from second-look hip arthroscopies and animal studies has suggested spontaneous labral regrowth may occur after débridement. However, these observations have not been systematically confirmed.

Surgical Approaches for Cam Femoroacetabular Impingement: The Use of Multicriteria Decision Analysis

Claudio Diaz-Ledezma MD, Javad Parvizi MD

Currently, three surgical approaches are available for the treatment of cam femoroacetabular impingement (FAI), namely surgical hip dislocation (SHD), hip arthroscopy (HA), and the miniopen anterior approach of the hip (MO). Although previous systematic reviews have compared these different approaches, an overall assessment of their performance is not available.

Labral Injuries of the Hip in Rowers

Robert E. Boykin MD, Eric D. McFeely BA, Kathryn E. Ackerman MD, MPH, Yi-Meng Yen MD, PhD, Adam Nasreddine MA, Mininder S. Kocher MD, MPH

Injuries of the hip in the adolescent and young adult athlete are receiving more attention with advances in the understanding of femoroacetabular impingement (FAI), labral pathology, and hip arthroscopy. Labral tears have not been well characterized in rowers.

Why Do Hip Arthroscopy Procedures Fail?

Ljiljana Bogunovic MD, Meghan Gottlieb MSW, Gail Pashos BS, Geneva Baca BA, John C. Clohisy MD

Despite the successes of hip arthroscopy, clinical failures do occur, and identifying risk factors for failure may facilitate refinement of surgical indications and treatment. Knowledge regarding the reasons for treatment failures may also improve surgical decision making.

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Nusret Kose MD, Ali Otuzbir MD, Ceren Pekşen PhD, Abdurrahman Kiremitçi MD, Aydın Doğan PhD

Despite progress in surgical techniques, 1% to 2% of joint arthroplasties become complicated by infection. Coating implant surfaces with antimicrobial agents have been attempted to prevent initial bacterial adhesion to implants with varying success rates. We developed a silver ion-containing calcium phosphate-based ceramic nanopowder coating to provide antibacterial activity for orthopaedic implants.

pHEMA-nHA Encapsulation and Delivery of Vancomycin and rhBMP-2 Enhances its Role as a Bone Graft Substitute

Xinning Li MD, Jianwen Xu PhD, Tera M. Filion PhD, David C. Ayers MD, Jie Song PhD

Bone grafts are widely used in orthopaedic procedures. Autografts are limited by donor site morbidity while allografts are known for considerable infection and failure rates. A synthetic composite bone graft substitute poly(2-hydroxyethyl methacrylate)-nanocrystalline hydroxyapatite (pHEMA-nHA) was previously developed to stably press-fit in and functionally repair critical-sized rat femoral segmental defects when it was preabsorbed with a single low dose of 300 ng recombinant human bone morphogenetic protein-2/7 (rhBMP-2/7).

Weber Osteotomy for Large Hill-Sachs Defects: Clinical and CT Assessments

Alexandra L. Brooks-Hill BPHE, MD, DipSportMed, Bruce B. Forster MD, Case Wyngaarden BSc, MD, Robert Hawkins MD, William D. Regan MD

The Weber derotation osteotomy is an uncommon procedure that typically is reserved for patients with engaging Hill-Sachs defects who have had other surgical treatments for shoulder instability fail. It is unknown whether the desired humeral derotation actually is achieved with the Weber osteotomy.

Does Radiographic Beam Angle Affect the Radiocapitellar Ratio Measurement of Subluxation in the Elbow?

Fannie McCann BSc, Fanny Canet MScA Ing, Emilie Sandman MD, Yvan Petit PhD Ing, Dominique M. Rouleau MD, MSc, FRCSC

Radial head alignment is the key to determine elbow reduction after treatment of subluxations or Monteggia fractures. The radiocapitellar ratio (RCR) quantifies the degree of subluxation, by evaluating radial head alignment with the capitellum of the humerus; this ratio is reproducible when measured on true lateral radiographs of nonsubluxated elbows. However, the impact of beam angulation on RCR measurement is unknown.

Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

Ernest L. Sink MD, Peter D. Fabricant MD, Zhaoxing Pan PhD, Michael R. Dayton MD, Eduardo Novais MD

The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress.

Can Residual Leg Shortening Be Predicted in Patients With Legg-Calvé-Perthes’ Disease?

Kwang-Won Park MD, Kyu-Seon Jang MD, Hae-Ryong Song MD, PhD

Although Legg-Calvé-Perthes’ disease (LCPD) is frequently associated with varying degrees of femoral head deformity and leg length discrepancy (LLD), no factors that predict residual shortening have been clearly identified.

Reliability of Overcoverage Parameters With Varying Morphologic Pincer Features: Comparison of EOS® and Radiography

Shafagh Monazzam MD, Mandar Agashe MD, Harish S. Hosalkar MD

Multiple radiographic parameters used for diagnosis and quantification of morphologic pincer features have emerged, but the degree to which pelvic tilt or rotation affects conventional radiography and EOSis unknown.

Which Functional Assessments Predict Long-term Wear After Total Hip Arthroplasty?

Ryan K. Takenaga MA, MD, John J. Callaghan MD, Nicholas A. Bedard BS, Steve S. Liu MD, Yubo Gao PhD

There is a paucity of literature concerning functional assessment at long-term followup of THAs in general and in young patients specifically. Functional data may be useful in determining differences in the performance of various implants and surgical techniques in THA.

Has Total Hip Arthroplasty in Patients 30 Years or Younger Improved? A Systematic Review

Muyibat A. Adelani MD, James A. Keeney MD, Allison Palisch BS, Susan A. Fowler MLIS, John C. Clohisy MD

The evolution of total hip arthroplasty (THA) generally has led to improved clinical results. However, THA in very young patients historically has been associated with lower survivorship, and it is unclear whether this, or results pertaining to pain and function, has improved with contemporary THA.

Translation and Cultural Adaptation of the Turkish Lysholm Knee Scale: Ease of Use, Validity, and Reliability

Derya Celik PT, PhD, Dilber Coşkunsu PT, MSc, Önder Kılıçoğlu MD, PhD

The Lysholm knee scale, first published in 1982, is an eight-item questionnaire designed to evaluate patients after knee ligament injury. However, as a tool developed in English, its use as a validated instrument has been limited to English-language populations.

Older Age Increases Short-term Surgical Complications After Primary Knee Arthroplasty

Molly C. Easterlin BA, Douglas G. Chang MD, PhD, Mark Talamini MD, David C. Chang PhD, MPH, MBA

Age is a known risk factor for complications after knee arthroplasty; however, age-related risks for a variety of complications of total and partial knee arthroplasties have not been well quantified.

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

Mathias Glehr MD, Joerg Friesenbichler MD, Günter Hofmann MD, Gerwin Alexander Bernhardt MD, Maximilian Zacherl MD, Alexander Avian PhD, Reinhard Windhager MD, Andreas Leithner MD

A periprosthetic joint infection is one of the most challenging complications associated with THA and TKA. In the diagnostic process for detecting a periprosthetic joint infection, one of the most important steps is analysis of laboratory infection biomarkers.

Better Quality of Life After Medial Versus Lateral Unicondylar Knee Arthroplasty

Thoralf R. Liebs MD, Wolfgang Herzberg MD

The number of unicompartmental knee arthroplasties (UKAs) is growing worldwide. Because lateral UKAs are performed much less frequently than medial UKAs, the limited information leaves unclear whether UKAs have comparable survival and health-related quality of life (HRQoL) of the lateral UKA to medial UKAs.

Association Between Measures of Patella Height, Morphologic Features of the Trochlea, and Patellofemoral Joint Alignment: The MOST Study

Joshua J. Stefanik MSPT, PhD, Ann C. Zumwalt PhD, Neil A. Segal MD, John A. Lynch PhD, Christopher M. Powers PT, PhD

Patellofemoral joint (PFJ) malalignment (lateral patella displacement and tilt) has been proposed as a cause of patellofemoral pain. Patella height and/or the morphologic features of the femoral trochlea may predispose one to patella malalignment.

Consensus Statement from the Consensus Conference on Bilateral Total Knee Arthroplasty Group

Stavros G. Memtsoudis MD, PhD, Mary Hargett BS, Linda A. Russell MD, Javad Parvizi MD, William L. Cats-Baril PhD, Ottokar Stundner MD, Thomas P. Sculco MD

Controversy exists regarding many aspects of decision making pertaining to same-day versus staged bilateral TKA (BTKAs), including patient selection, perioperative management decisions, and other important choices.

Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

Cesare Faldini MD, Francesco Traina MD, Alberto Di Martino MD, PhD, Matteo Nanni MD, Francesco Acri MD

Neglected clubfoot in older children is characterized by a stiff, nonreducible deformity with relative elongation of the lateral column of the foot with respect to the medial column. Surgical correction often has involved a double osteotomy with elongation of the medial column and shortening of the lateral column, or the use of an external fixator to achieve more gradual correction. Both approaches have shortcomings.

Iterative Curettage is Associated with Local Control in Giant Cell Tumors Involving the Distal Tibia

Saleh A. AlSulaimani MBBS, Robert E. Turcotte FRCSC

The distal tibia is an unusual location for a giant cell tumor (GCT). Treatment choices are unclear because of their rarity, the anatomy of the ankle, and difficulties associated with reconstruction.

Percutaneous Doxycycline Treatment of Aneurysmal Bone Cysts With Low Recurrence Rate: A Preliminary Report

William E. Shiels DO, Joel L. Mayerson MD

Aneurysmal bone cyst (ABC) has a recurrence rate of between 12% and 71% without en bloc resection or amputation. There is no percutaneous ABC treatment drug regimen demonstrating consistent evidence of bone healing with recurrence of < 12%. Doxycyline has properties that may make it appropriate for percutaneous treatment.

Malignant Lymphoma of Bone: A Review of 119 Patients

Emre Demircay MD, Francis John Hornicek MD, PhD, Henry J. Mankin MD, Henry Degroot MD

Lymphoma of bone is uncommon. As a result of this, many aspects of primary lymphoma of bone (PLB) are controversial: the definition, treatment strategies, response criteria, and prognostic factors.

Treatment and Displacement Affect the Reoperation Rate for Femoral Neck Fracture

Donavan K. Murphy MD, MSc, MBA, Timmothy Randell MD, Kindyle L. Brennan PhD, PT, Robert A. Probe MD, Michael L. Brennan MD

Femoral neck fractures (FNFs) comprise 50% of geriatric hip fractures. Appropriate management requires surgeons to balance potential risks and associated healthcare costs with surgical treatment. Treatment complications can lead to reoperation resulting in increased patient risks and costs. Understanding etiologies of treatment failure and the population at risk may decrease reoperation rates.

Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

Emilija Dubljanin-Raspopović MD, PhD, Ljiljana Marković-Denić MD, PhD, Jelena Marinković MD, PhD, Una Nedeljković MD, Marko Bumbaširević MD, PhD

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality.

Swiss Contributions to War Surgery During the Great War

Marcelin Oliver Draenert PhD

The role of neutral Switzerland during World War I is somewhat mysterious and its diplomatic history has never been fully disclosed. One of the activities might have determined its role: based on its relationship to the International Committee of the Red Cross, wounded multinational prisoners-of-war were interned in Swiss hospitals and Swiss physicians worked in a medical capacity in military hospitals on both sides of the front.

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